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Based on record review, document review, staff interview and policy review, it was determined the facility failed to comply with the requirement to accept appropriate transfer of a patient requiring services that are available at the facility for 1 (#21) of 21 sampled patients. See A 2411.

Based on record review, document review, staff interview and policy review, it was determined the facility failed to comply with the requirement to accept appropriate transfer of a patient requiring services that are available at the facility for 1 (#21) of 21 sampled patients. This practice results in delay in the provision of required care of the patient.

Findings include:

Review of the facility ' s policy " EMTALA- Duty to Accept " , # 1.780.007, last reviewed 2/12, requires that a hospital with specialized capabilities shall accept, from a transferring hospital, an appropriate transfer of an individual with an emergency medical condition. It further indicated that only the facility ' s Chief Executive Officer or designee and the emergency physician in consultation with the appropriate hospital representative have the right to accept or refuse to accept a patient transfer. Interview with a Behavioral Health intake person on 8/9/12 at approximately 2:30 p.m. revealed that one of the facility ' s psychiatrists is to make the final decision regarding acceptance or refusal of a transfer to Behavioral Health. The intake form indicated that referral to the psychiatrist was not required.

Review of the facility ' s policy " Baker Act (Involuntary and Voluntary Treatment/Transfer), # 2.917.003, last revised 2/12, revealed that a Baker Act Receiving facility is designated by the Department of Health and Human Services to receive and hold involuntary patients under emergency conditions or for psychiatric evaluation and to provide short-term treatment. Review of documentation from the Department of Children and Families (DCF) revealed the facility is a Baker Act Receiving Facility. The policy also indicated that the Baker Act is initiated if it is believed that " there is substantial likelihood that without care or treatment the person will cause serious bodily harm to himself/herself or others in the near future, as evidenced by recent behavior."



Review of the medical record of patient number 21 revealed the patient was taken facility #1's (transferring facility) ED on 7/30/12 at approximately 11:29 a.m. A medical Screening examination was initiated by the ED physician at approximately 12:49 p.m. The patient was evaluated in the ED by a psychiatrist at 1:15 p.m. for " bizarre behavior ". The psychiatrist documented the diagnosis of Bipolar with psychotic features verses schizoaffective disorder. She determined the patient required psychiatric hospitalization and initiated the Baker Act for involuntary admission for psychiatric evaluation. The ED physician documented the patient was medically clear for psychiatric admission at 4:20 p.m. She also noted the patient would be transferred to an outside facility. Review of the Social Worker notes revealed a note entered at 9:16 p.m. indicating that the patient ' s information had been faxed to 4 facilities that are designated baker act receiving facilities. The note also indicated that facility #2 (Brandon Regional Hospital) was contacted via phone call. The note further indicated that the Social Worker had phoned the Behavioral Health intake person at facility #2, requesting the facility accept the transfer of the Baker Acted patient for admission. The note indicated the intake person asked for the patient ' s funding source and then told the Social Worker that she had been instructed by her supervisor to decline transfer of unfunded patients. Review of the call log for Behavioral Health intake revealed an entry on 7/30/12 at 8:53 p.m. indicating the name of the person at the transferring hospital and the funding source of charity pending. The disposition time was also 8:53 p.m. The " Behavioral Health Center Inquiry Form " related to that entry listed the name of the caller from the transferring facility, the fact that the patient was in the facility ' s ED, was a Baker Act patient and was unfunded. It further indicated that referral to a psychiatrist for review was not required. Review of the medical record from facility #1 revealed another Social Work note on 7/31/12 that indicated a second call and fax of patient information to the facility #2 was placed. The outcome of that contact was not documented. Review of the Behavioral Health call log revealed no entries for that date for the facility #1. Further review of the medical record of patient #21 revealed that she was finally transferred to a local crisis stabilization unit on 8/1/12 at 1:36 p.m. This was approximately 50 hours from the time she presented to the ED.

Review of the Behavioral Health Unit census at facility #2 revealed there were 16 patients on 7/30/12 and 19 patients on 7/31/12. The Behavioral Health unit is a 24 bed unit. There were beds available at the time of the requests for transfer. The facility failed to accept an appropriate transfer of an individual who required the facility's specialized psychiatric capability and capacity to treat patient #21 on 7/30/12 and 7/31/12.

The Behavioral Health intake person at facility #2, who was on duty on 7/30/12, was interviewed on 8/9/12 at approximately 4:00 p.m. She stated that the Social Worker at the transferring facility volunteered the information concerning the patient ' s funding source. She denied refusing the transfer and asked that the Social Worker at the transferring facility fax the patient ' s information. This information was not indicated on the " Behavioral Health Center Inquiry Form " completed by the intake person, however. She indicated no further actions were required on the form. There were no copies of the patient ' s records from the transferring facility available at facility #2. The intake person indicated they were never faxed by facility #1.

The Risk Manager at facility #1 was asked to verify the documentation by the social workers regarding the accuracy of the information related to contact with the facility being investigated. She provided email documentation that both social workers stated the documentation was accurate.

The Behavioral Health Director at facility #2 was interviewed on 8/9/12 at approximately 2:00 p.m. He indicated that the intake workers do not request funding information from the facilities seeking to transfer patients to the Behavioral Health unit. Review of the intake log revealed that the funding source for most of the patients seeking admission to the unit was listed. The director indicated that most of the transferring facilities send the face sheet, which has the funding source listed.